Oxygen and Croup Flashcards
Why is oxygen prescribed to patients?
prescribed for hypoxaemic patients to increase alveolar oxygen tension and decrease the work of breathing
1) what should oxygen saturation be in most acutely ill patients with a normal or low arterial carbon dioxide (PaCO2)?
2) what clinical situations it is more appropriate to aim for the highest possible oxygen saturation until the patient is stable?
1) 94–98% oxygen saturation
2) cardiac arrest and carbon monoxide poisoning
what is the target oxygen saturation indicated for patients at risk of hypercapnic respiratory failure?
88–92% oxygen saturation
Low concentration oxygen therapy is reserved for patients at risk of hypercapnic respiratory failure. list the patients who are most likely to be at risk of this condition
1) COPD
2) advanced cystic fibrosis;
3) severe ankylosing spondylitis;
4) severe lung scarring caused by tuberculosis
5) an overdose of opioids, benzodiazepines, or other drugs causing respiratory depression.
In patients who are at risk of hypercapnic respiratory failure, how should oxygen therapy initially be administered until blood gases can be measured?
1) Using a controlled concentration of 28% or less, titrated towards a target oxygen saturation of 88–92%.
2) Aim is to provide enough O2 to achieve an acceptable arterial oxygen tension without worsening CO2 retention and respiratory acidosis.
what is the benefit of Long-term administration of oxygen in COPD?
Prolongs survival in some patients
Assessment for long-term oxygen therapy requires measurement of arterial blood gas tensions. when should measurements be taken?
Measurements should be taken on 2 occasions at least 3 weeks apart to demonstrate clinical stability, and not sooner than 4 weeks after an acute exacerbation of the disease.
patients who are not on long-term oxygen therapy can be considered for ambulatory oxygen therapy. who would be suitable to receive ambulatory oxygen therapy and which patients is it not recommended in?
1) ambulatory oxygen would be considered if there was evidence of exercise-induced oxygen desaturation and of improvement in blood oxygen saturation and exercise capacity with oxygen
2) not recommended for patients with heart failure or those who smoke
What is croup?
common childhood disease usually caused by a virus. It is characterised by the sudden onset of a seal-like barking cough usually accompanied by stridor, hoarse voice, and respiratory distress due to upper-airway obstruction. Symptoms are usually worse at night.
How should mild croup be managed and what drugs are used?
1) usually self-limiting and symptoms usually resolve within 48 hours. If managed at home, use paracetamol or ibuprofen to control fever and pain
2) Treatment with a single dose of a corticosteroid by mouth may be of benefit
what drugs are typically used to manage croup?
1) All children with mild, moderate, or severe croup should receive a single dose of oral dexamethasone (0.15 mg per kg body weight).
2) If the child is too unwell to receive medication, inhaled budesonide or intramuscular dexamethasome are possible alternatives.
How should severe croup (or mild croup that might cause complications) be managed and what medication should be used?
1) hospital admission; a single dose of a corticosteroid (e.g. dexamethasone or prednisolone by mouth) should be administered before transfer to hospital
2) in hospital, dexamethasone or budesonide (by nebulisation) will often reduce symptoms; the dose may need to be repeated after 12 hours if necessary
what treatment can be considered for severe croup not effectively controlled with corticosteroid treatment
Nebulised adrenaline/epinephrine (1 mg/mL) with close clinical monitoring; the effects of nebulised adrenaline/epinephrine last 2–3 hours
